The shadow of youth suicide hangs heavy over today's Indian Reservations and among urban Indian people. As in all societies there is no treasure as precious as that of the lives of the children. Suicide is the second leading cause of death among American Indian youth with a crude death rate of 37.1 per 100,000 (2.7 times that of youth of all races in the United States). Suicide is the fourth leading cause of death among American Indian youth ages 5 through 14. Within the Indian youth suicide group, American Indian children placed in non-Indian homes for adoptive or foster care suffer a rate of 70 suicides per 100,000, a rate that is six times higher than that of youth in the United States. Alaska Natives had the highest suicide rate in the nation in 2000, averaging 42.9 suicides per 100,000 people; over six times the national average. While suicide rates for youth 14 through 19 years old have decreased somewhat, rates for 10- and 14-year-olds are approximately four times higher than that for the general U.S. population and have continued to increase steadily.

Scholars and researchers point to important aspects of human behavior that can be applied to Indian youth. This set of relationships is composed of underlying causes that are generally circumstances in the individual's environment, precipitating stress events, personal feelings such as alienation, anomie, helplessness, hopelessness, and despair. These personal feelings are placed into motion by stressful events that are manifested by the development of suicidal thoughts and gestures, the culmination being the successful suicide act. Additionally, circumstances in the environment represent underlying factors such as economic and social conditions that contribute to suicide rates among Indian youth. What these scholars and researchers miss, however, is the interconnectedness of the American Indian spiritual world (spirituality) and the everyday process of life. For American Indians the spiritual is ever present in their world, from the time of awakening to the time of sleep. In some cases even the process of sleep, or dreaming, also has deep spiritual meaning. For American Indian youth one cannot separate the spiritual from the physical or emotional realities without causing severe trauma.

American Indians in general have high rates of depression. Overwhelming stress from rapid acculturation and loss of spiritual and additional identity leads to a state of chronic depression. The unemployment rate for Indian people continues to be higher than national averages, and on some reservations unemployment is more than 60%. According to Census Bureau data for 1990, the median income of Indian families in the United States was $21,750-considerably lower than the national average of $35,225, and more than twice as many Indian people (51%) were living below the poverty level. The educational attainment of Indian people is also below national averages. While 20% of those 25 years and older in the general population have completed 4 years of college, only 9% of American Indian people have done so. Finally, alcoholism is a major threat to the survival of Indian culture as fewer traditional values and life ways are passed on to the youth in the society.

Environmental circumstances and coupled stress events place Indian youth on a dangerous path toward suicidal behavior. Stress events may include a death among the immediate or extended family members, failure in school or job, or conflict between white social values and deep-seated cultural beliefs. While most youth in America are faced with the problems associated with making the transition into adulthood, Indian youth face even greater conflicts than most other American youth, particularly due to their minority status, fewer economic and educational opportunities, and cultural differences. Indian adolescents must choose from at least two, not totally clear paths: traditional life on an Indian reservation or assimilation into an urban environment. Assimilation most often includes the abandoning of the spiritual world that provides a basis for who they are as an Indian person. Faced with this pressure, some- particularly those with little support who have suffered the consequences of prejudice, discrimination, and unclear and seemingly hostile values-turn to various forms of self-destructive behavior, including suicide. Alienation appears as an early symptom of fear and confusion, resulting from stress. This is often accompanied by dramatic changes in behavior patterns such as decline in school performance or in self-destructive acts such as alcohol or drug abuse. Helplessness furthers feelings of alienation and has been defined as a desire to escape from what one considers being an insoluble problem and having no hope that relief is possible in the future. It is at this point that the Indian youth begin to visualize thoughts of powerlessness over his or her environment. Events seem insurmountable, and the person now feels alone. These feelings often overshadow all others and quickly turn to a feeling of hopelessness. Socioeconomic factors as well as alcoholism can have a severe impact on family discord and dysfunction, which also contributes to the feeling of hopelessness and self-destructive behavior. It is at this point that the Indian youth is most vulnerable. Often human resources are few and Indian youth have a limited number of people with whom to consult. Many schools that serve American Indian students are unsupportive of the academic, social, cultural, and spiritual needs of Native students. Indian youth may face racism from their fellow students as well as inaccurate portrayals of Native Americans in American history. These events may further lower their selfesteem. According to the Group for the Advancement of Psychiatry, pathways to assimilation to dominant society norms are often blocked due to racism, and as a result, Indian youth slip into cultural marginalization.

They have at this point lost many essential values of traditional culture and have not been able to replace them by active participation in American society in ways that are conducive to enhanced cultural and psychological self-esteem. Without the help of friends and relatives, or if those are removed or fail, finality is near. Anomie is the next step when the Indian youth loses his or her sense of purpose in life and their personal identity. Anomie is followed rapidly by despair. When the Indian youth enters the final stage of despair, he or she falters between thoughts of life and death that is usually accompanied by severe withdrawal symptoms. Often subtle clues to suicide are given, while behavior usually changes dramatically. Talking about wanting to join dead relatives or having an experience of being visited by the dead may provide a clue to an impending suicide attempt. The individual seemingly will break the depression cycle, which may appear promising. However, it may simply mean that all options have been exhausted and that a plan for suicide has been developed. Intervention and planning are critical at this point because counseling may generate thinking around activities of life to detract from thoughts about death. Planned intervention must reconnect the at-risk person with a human resource that fits his or her particular need. This reconnection is often with members of the extended family, peers, or teachers. Another critical point of reconnection is with the Indian culture from which Native American people often draw their strength.